1285721191 NPI number — MS. AMY LOUISE AUBERTIN MS RD LDN

Table of content: MS. AMY LOUISE AUBERTIN MS RD LDN (NPI 1285721191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285721191 NPI number — MS. AMY LOUISE AUBERTIN MS RD LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUBERTIN
Provider First Name:
AMY
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS RD LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285721191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
191 DAMON ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHBY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-674-1189
Provider Business Mailing Address Fax Number:
978-386-0996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 BEDFORD STREET
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-674-1189
Provider Business Practice Location Address Fax Number:
978-386-0996
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  405 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com